Active NPI
Melanie Boerio
- Pediatric Nurse Practitioner
- Columbia, MO
National Provider Identifier
1265640783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 135334
- Practice address
- 1316 Old Highway 63 S
Suite 200
Columbia, MO 65201-6092 - Phone
- (573) 445-4272
- Fax
- (573) 815-2477
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 135334 | MO | Primary |
Addresses
Primary practice location
1316 Old Highway 63 S
Suite 200
Columbia, MO 65201-6092
Mailing address
5308 Tiptree CT
Columbia, MO 65203
Phone (573) 474-1054
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 135334 | Other | MO | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 135334 | MO | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tiger Pediatrics LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Columbia, MO
- NPI 1871872770
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364256000000",
"number": "1265640783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5308 TIPTREE CT",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "65203",
"telephone_number": "573-474-1054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 OLD HIGHWAY 63 S",
"address_2": "SUITE 200",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652016092",
"telephone_number": "573-445-4272",
"fax_number": "573-815-2477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERIO",
"first_name": "MELANIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2013-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MO",
"license": "135334",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "135334",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.